CT Anthem BC/BS / Aetna..AND MY SURGERY!

To Whom it May Concern: I just got it STRAIGHT from my Doc's office that CT Anthem DEFINITELY will be changing its WLS criteria as of January 1, 2005...they are going to get more stringent due to the flood of folks now requesting WLS...I was also told that AETNA was doing it too...Dr. Tishler's office has already been notified of this!! So get hustling if you have these insurances! Consequently...(GULP)...My doc is going to try and get me into surgery before the end of DECEMBER!!!!! (GULP) HOLEY MOLEY!!!!! Well...I just ABSOULUTELY quit smoking! Merry Christmas to ME!!! Oh my Lord..the rubber is meeting the road!!! Now I have to scramble to get ALL kinds of things done..and what a lump I have in my throat..I have been racing like a mad woman to get stuff done just because I wanted it out of the way...but WHO the HECK KNEW!!!???? Please keep my sometimes cantankerous but well meaning tail in your prayers! Sher'

Sher, It is really unfortunate that so many people will not be able to have surgery! I am glad you have a Dr who will work with you and get you in (unexpectedly) so quickly! Good luck, Carmen

Thanks Carmen!! Hope you and you family have a wonderful Holiday! Sher'

Sher, this does not effect State of Connecticut employees. I have checked with Anthem and with the Comptroller, and with my employer and they all say the same thing. Anthem has not notified us that they are making any changes whatsoever, Anthem stated that everything for us is staying the same. If they intend to change anything, they can not do it until OUR contract is up which is July 2005. So state of Ct employees relax. Dont forget each company negotiates with Anthem for their own contracts with Anthem. It is they that decide what they want covered and what they dont, in order to keep THEIR costs down. If Anthem and that company want to negotiate changes to a contract they can not do it in mid stream, they must wait for open enrollment to look at what is going to be covered. If they intend to change their minds on anything midstream they MUST (it is the law) inform the contract holders. I hope this clears this up for everyone. If you have Anthem, you must check to see if YOUR policy is affected. If your open enrollment is in January, chances are it is. If your open enrollment is not until July, chances are it will change then. I think that Anthem and employers are going to make some changes to make this surgery stricter, since everyone is jumping on the band wagon (no pun intended). But if you have the co-morbidities, then you probably have nothing to worry about. Lauren

What a RELIEF!!! I think I will call the RN coordningator and let her know! I thought she knew what she was talking about..or should I say..that she was taking into account the fact that I am a state employee...Our open enrollment period for DMHAS is in May...so that is likely thje deadline..thanks so much for clarifying!!! i guess for myself I was doing "The sky is falling! The sky is falling!" Best Wishes for a Blessed Holiday! Sher'

Hi Lauren, Was wondering what kind of proof you had to submit of past diets...i went to Weigh****chers and Diet Center.etc..YEARS ago as well as to a couple of "diet doctors" who have faded from the scene...we are working to get a stronger letter fro my PCP..but was just curious! Congrats on your approval! Sher'

Thanks Lauren. I am a State Employee and was worried. I am waiting for my appt with my surgeon and would of been very upset if this change would of happened under BC/BS. Antoinette.

Sher' Congrats on quitting smoking! I was talking the one of the docs I work for and he told me that BC is definitely not paying next year and there is an extra malpractice clause that surgeons have to take into consideration next year. He said they are cracking down on general surgeons who are not qualified... There is good and bad to both. I know public pressure will make these ins reconsider their policies next year....but this sure sucks for others wanting the surgery now! Good luck to you! Joanie

Hi Joanie! Yes it does! Oh the times they are a changing! I guess if this does not fly now for whatever reason I will really be scrutinizing policies in May during open enrollment! Well..it is out of my habds now and if this is suppposed to happen it will...I have done all of the legwork. Warm Wishes for a Wonderful Holiday..and thanks for the food logs...I am going to be referring to them a LOT!!! Nice new pic by the way! Sher'

hey sher, i am having the same problem. My dh employer is changing from connecticare to anthem. i called Dr. tisher office to see if i can get this done this month. Wish me luck